Intermountain Value-Based Care Subsidiary Castell Expanding Footprint

Castell, an Intermountain Healthcare subsidiary with a focus on value-based payment analytics, is expanding beyond its Utah home to work in Nevada and Idaho and is putting partnerships in place with payers such as United Healthcare.

Companies that spin out of large integrated health systems often have an advantage over small startups because they have had executive sponsorship and the cooperation of  internal clinical organizations in applying data analytics to specific pain points in the organization. In a recent interview, Andrew Sorenson, Castell’s chief analytics officer, described the company’s origin and trajectory.

As early as 2011 Intermountain decided to begin a transition toward value-based care, because the Utah-based integrated health system saw it as the way to align incentives between payers and providers and the communities they serve. Executives envisioned they by 2017 the majority of Intermountain’s business would be in value-based arrangements. “It has taken a little bit longer,” Sorenson said, but Intermountain has continued to make investments in value-based care capabilities.

“We had a department inside Intermountain that helped transition a lot of our operations to build that value-based care muscle,” Sorenson said. “We started to see great momentum and stellar results related to our value-based care activities.”

But as they saw continued improvements in value-based care performance, those gains were disproportionately seen within Intermountain’s employed medical group. Of the patients they serve in value-based care arrangements, about half receive primary care services from non-employed providers. “We realized that in order to continue to drive better affordability and quality here in Utah, we would need an organization positioned to deliver products and services to other primary care providers in the area. That is what culminated in the creation of Castell. It brings products and services that support payers and providers in the transition to value-based care and helps them thrive in that environment.”

The decision was made to create Castell in May 2019. Sorenson joined in July 2019 as employee No. 1. The company launched in January 2020 and has since grown to approximately 350 employees.

I asked Sorenson why there was such a disparity in results between the employed and non-employed physician groups.

Working for a large organization, Intermountain employees benefit from a lot of its central functions that the organization has the scale to invest in, he said. “For example, in order to support value-based care efforts when I was an Intermountain employee, my analytics team went from four employees to 20 employees focusing on analytics. That is an investment Intermountain could justify, but something that would be really hard for a small primary care practice to try and match in terms of investment,” Sorenson explained. “One of the difficulties for small practices is how you make investments needed to turn on value-based care services and analytics and ensure you have the right data when you’re a much smaller group. Scale was part of it. Another was aligning incentives and not really having the leverage to push groups to do new things. Castell can create programs that can incentivize the activities that are really critical to value-based care.”

Sorenson stressed is that their goal is to work with organizations of all sizes. “We have been really deliberate in creating offerings that cater to really large multispecialty practices and clinics as well as small clinics. We have offerings that will meet groups where they are at in terms of sophistication and motivation. We ingest data from provider organizations and combine it with data we have in our platform in order to turn on our analytics platform. Fortunately, they don’t need to make a lot of technology investments for this to work. We own the complexity of doing that. It makes it easier to partner with more organizations.”

Castell manages an accountable care organization for Intermountain, and Sorenson said the company would be open to conversations with other ACOs about working with them.

Last year Castell Accountable Care (previously Intermountain Accountable Care) received a quality score of 98.88 percent, placing it among the top 5 percent of ACOs nationally for quality. Simultaneously, the Castell ACO generated $10 million in savings for Medicare.

Sorenson said that success can be attributed to ensuring the right incentives are in place and that the information clinicians need is at their disposal to ensure services are provided in the right setting at the right cost. “In the past, some of that data was limited to what had happened in a specific clinic,” he said. “We have put committees in place to help identify opportunities to drive better quality performance and are able to build on the Intermountain medical group’s history of delivering high-quality care.”

Castell also has developed a close working relationship with Arcadia, a healthcare data and software company focused on value-based care. Arcadia recently launched Vista, a web-based enterprise business intelligence product designed for value-based care leaders and analysts. 

“We are excited about the possibilities,” Sorenson said. “When we have an idea, they are willing to come to the table and bring something to life.”

Castell was an early adopter of Vista, using it to build polypharmacy dashboards in support of a pharmacy strategy for patients with multiple expensive drugs. “We had some medical directors who had a great idea to improve the cost of care. We worked with Arcadia over a week to partner to bring this to life. Prior to Vista coming online, moving that quickly would have been difficult. They are really nimble in working with us.”

Speaking of being nimble, Sorenson described how Castell has been working in support of Intermountain’s adoption of a hospital-at-home program during the pandemic. “We went from not having hospital at home to having our first patients in about six weeks,” he said. This was a partnership between Intermountain, Castell and some technology partners that were able to bring infrastructure to the table to make sure the remote monitoring and other things critical to that program could be turned on very quickly. "It is something that is a hallmark of how Castell operates," he added. "When we hear from the market, they want us to be responsive when new opportunities arise, and be nimble. Hospital at home is proof positive that we can do very complex things quickly.”